A 35 year old male presents with diarrhea and abdominal pain. This is seen on endoscopy. The patient does not take NSAIDs and is negative for H. pylori. When you take a further history, you find that the patient had a parathyroid tumor at age 30 which was successfully treated. His mother had some "pituitary thing."Challenge: What's the cause of the finding seen on endoscopy? The patient also has an familial endocrine disease; what is it?
Related Questions:
1. What's the endoscopy finding?
2. The second part of the challenge involves "3P's." What are they?
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The image shows multiple small ulcers in the distal duodenum in a patient with a gastrinoma (Zollinger-Ellison syndrome). Though most peptic ulcers are attributable to NSAIDs and H. pylori, multiple peptic ulcers with diarrhea and absence of those risk factors suggests Zollinger-Ellison.
The patient also has multiple endocrine neoplasia type 1 (MEN1), an autosomal dominant predisposition to tumors of the parathyroid glands (at a young age), anterior pituitary, and pancreatic islet cells (3P’s; the last one includes gastrointestinal adenoma). For review, MEN2a involves medullary thyroid cancer, pheochromocytoma, parathyroid hyperplasia; MEN2b involves just medullary thyroid cancer and pheochromocytoma; and familial medullary thyroid cancer is a related syndrome.
Sources: Wikipedia, UpToDate.
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